Overcoming runners knee. 7 practical ways to reduce anterior knee pain

How to Reduce Anterior Knee Loading to keep training despite your runner's knee pain.

You’ve trained for weeks. You’ve told your friends and family you’re doing a marathon. You’re going for a shiny new PB. You’ve put the work in. Then, without warning you feel the dreaded niggle at the front of your knee. Carry on. It will pass soon enough… right?! The knee pain gets worse and suddenly you’re faced with the prospect of pulling out of your marathon or race. This blog is here to say don’t lose hope! There are lots of simple, practical ways to help this problem.

I’m Marcus, a seasoned marathoner and specialist running physiotherapist. With this guide I aim to show you practical ways to reduce knee loads and help you make it to race day while maintaining your training. At our clinic, OnTrack Health and Performance, we are currently seeing lots of marathon runners with this condition keen to make it to the start line of Manchester and London Marathons.

Patellofemoral Pain Syndrome (PFPS) or runners knee as it is affectionately known, is a common and frustrating injury for lots of runners. Research shows it accounts for a staggering 48.8% of all knee injuries in runners (Taunton et al., 2002). Running appears to affect knees more than ankles and hips. From walking to running we see 4.6 times greater forces at the patellofemoral joint (the front of the knee). It is therefore no surprise that knee pain can become a major obstacle to training and racing.

Patellofemoral pain (runners knee) is often loacted at the front of the knee, under or around the kneecap.

The good news? There are strategies to reduce knee loading, allowing you to continue training and reach race day pain-free. Below, we’ll explore the key risk factors for runner’s knee and practical ways to modify your training to protect your knees.

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Risk Factors for Runner’s Knee

Certain factors increase the likelihood of developing PFPS (Willy et al., 2019).

• Previous knee pain – If you’ve had PFPS (runners knee) before, you’re more likely to experience it again.

• Sport specialisation – Runners who focus exclusively on running without cross-training may be at higher risk.

• Increased training load – Sudden spikes in mileage, especially involving downhill running, can overload the knee.

• Female runners – Women are 2.2 X more likely to experience runner knee.

  
  

Practical ways to Reduce Knee Loading and Keep training:

1)      Train on an Incline

I hate treadmill running, with a passion. I hate knee pain even more though. Incline treadmill running can be a very effective way of reducing knee loads.

• Running on a 5% incline can reduce knee loading by up to 30% (Willy et al., 2016). I would suggest taking it up to a less extreme 3% incline.

• Incline running naturally increases your cadence, which can further reduce knee stress.

  
  

  

  Incline hill reps helped me to keep training some intensity while recovering from patellofemoral pain.

  
  

2) Increase Your Running Cadence

• A higher cadence (steps per minute) shortens stride length and decreases the braking forces at the knee which are associated with patellofemoral joint loading.

• Try increasing your cadence by 5-10% to reduce impact forces. It can be useful to use a metronome app. There’s even spotify playlists for specific BPM/cadence cues. Volume up, Pain down!

  
  

3) Use Patella Taping

• Patella taping can help reduce pain and improve knee stability (Petersen et al., 2016).

• A physiotherapist can guide you on the best taping technique for your knee and this usually involves Kinesiology Tape.

  
  

4) Consider Foot Orthoses

• Foot orthoses can also help. The evidence tells us over-the-counter or ‘off the shelf’ insoles are as effective as bespoke, prescribed insoles when it comes to reducing patellofemoral pain (Matthews et al., 2020).

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5) Remove Speed Work

• High-speed running increases knee forces. A 15% reduction in speed can result in upto 7.5% less knee loading.

• If knee pain is an issue, focus on easy-paced, steady running instead or speed or track sessions.

6) Avoid Downhill Running

• Downhill running significantly increases anterior knee stresses.

• Hill training is often an essential part of training. Walking the downhills or doing hills on a treadmill may be required while your knee recovers.

  
  

7) Choose a Lower Drop Shoe

• Running shoes with a lower heel-to-toe drop (the difference between the stack height at the heel and toe of the shoe) can reduce knee loading by 10%. Many running shoes now have a high heel drop. You can easily check the heel drop of your shoe with a simple google search.

• Aim for a drop of 4mm or less if knee pain is an issue. Be aware that very low drop shoes will increase achilles loading, which may increase risk of conditions like achilles tendinopathy.

  
  

  

  Strength and Conditioning, which I haven't discussed in this blog, is an essential part of treatment of patellofemoral pain.

Final Thoughts

There is no ‘cure’ for runners knee. Managing runner’s knee is all about modifying training to reduce knee stress while maintaining fitness. Specific strengthening exercises are also essential, which I haven’t discussed in this blog. By adjusting your running terrain, cadence, footwear, and training intensity, you can continue running and make it to race day strong and pain-free.

This blog should not be a replacement for professional medical advice. An assessment with a physiotherapist is essential to establish a formal diagnosis.

For more expert advice on running injuries and physiotherapy, contact us.